Degenerative Mitral Stenosis Unmet Need for Percutaneous Interventions

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Presentation transcript:

Degenerative Mitral Stenosis Unmet Need for Percutaneous Interventions Sud K1, Agarwal S1, Parashar A1, Raza MQ1, Patel K1, Min D1, Rodriguez LL1, Krishnaswamy A1, Mick SL1, Gillinov AM1, Tuzcu EM1, Kapadia SR2.

DMS 8% patients with MAC 15% of patients with MS in developed countries 60% of patients more than 80 years MAC Stress to the annulus HTN, AS, HOCM, etc. + Atherosclerosis RF Progression of MS (0.8±2.4 mm Hg/y)

Quantification of MS

Outcomes of Surgery

Transcatheter MVR

Approach

MAC Study Cleveland clinic echocardiographic database : 1996-2012 All Patients with MAC included; Patients with rheumatic heart disease excluded 3 groups based on severity of MAC: Mild, Moderate and Severe Primary outcome: All- cause mortality Secondary Outcome: Predictors for all-cause mortality

Characteristics Baseline characteristic (N=11,636) n (%) Age, median (IQR) 72 (65-79) Females 5235 (44.9) Caucasians 9902 (85.1) Hypertension 3751 (32.23) Diabetes Mellitus 1940 (16.7) Hyperlipidemia 3207 (27.6) Renal Failure 1025 (8.8) Smoking 2556 (21.9) History of MI 1036 (8.9) Prior CABG 756 (6.5)

Outcome of Patients

MS

MR

Survival with MAC

Summary A significant proportion of patients with MAC have coexisting MR. Patients with moderate/ severe MAC have worse survival as compared to patients with mild MAC. This is true for patients who have isolated MR or isolated MS. Patients with coexisting MS and MR have similar survival irrespective of the severity of MAC. There was a ‘dose–response’ relationship between the severity of MAC and long–term survival. Old age, African American ethnicity, diabetes mellitus, chronic kidney disease, moderate/ severe MAC, moderate / severe MR and severe MS are independent predictors of all- cause mortality in patients with MAC.